Clinical outcomes and return to sport after repeat-revision ACL reconstruction: 2-year minimum follow-up

OBJECTIVES: Anterior cruciate ligament reconstruction (ACLR) is one of the most common procedures performed by orthopaedic surgeons to date. As the number of ACL reconstructions continues to increase, revision and multiple revision scenarios will become more frequent. The purpose of our study was to retrospectively analyze functional outcomes, return-to-sports and concomitant procedures in a series of patients who had undergone repeat revision surgery. METHODS: We retrospectively evaluated a consecutive series of patients operated between 2011 and 2016 with a minimum follow-up of 2 years. Surgical procedure, type of graft and fixation were recorded. IKDC evaluation, Lysholm score, KOOS score, Tegner scale, return-to-sports and a radiographic evaluation were performed. RESULTS: Seven patients were included for analysis with an average age at the second revision of 34 years (range 22-49). The contralateral knee was intact in 5 cases while in the remaining 2 an ACLR had been performed. The average follow-up was 35 months (SD 17; median 27 [IQR 24-39 months]). The graft used for ACLR was: 1 ipsilateral BTB autograft and 6 allografts. In three cases, an associated lateral extra-articular procedure was performed. Three (43%) patients had a meniscal tear; two required partial meniscectomy and 1 was sutured. Three (43%) patients had grade III chondral lesion and we performed microfracture. All patients had a side-to-side difference of less than 5 mm in the arthrometric evaluation and none had residual rotational laxity. The median pre and postoperative IKDC score was 60 (IQR 45-68) and 89 (IQR, 65-94) respectively (p 0.021). The median pre and postoperative Lysholm score was 69 (IQR, 55-80) and 91 (IQR, 86-100) respectively (p 0.S007). The median postoperative KOOS score was: Pain 93, Symptoms 94, ADL 100, Sports 90, QOL 56. Three (43%) patients returned to their previous sports activity level at final follow-up. Three switched to a less demanding activity, whereas 1 discontinued contact sports. No significant osteoarthritic changes were observed. The mean posterior tibial slope was 8° (SD 2.7; median 7 [IQR 10-6]). CONCLUSION: Repeat revision ACLR was effective in restoring knee stability and improving functional outcomes in our patients when compared to their preoperative state. However, only 43% returned to their pre-injury level of sports activity.